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About interdisciplinarity
9th SIOG Meeting, October 16–18, 2008, Montreal, Canada: Friday, October 17, 2008 While in some centers only the classical MGE is used, in some others also screening tests are included, even if the results of a validation of a short test versus the classical MGE in older cancer patients are still not available. In a minority of cancer centers, where a structured relationship with Geriatricians exists, also an extended Geriatric Evaluation is carried out, whenever a therapeutic decision on the appropriate cancer therapy for frail patients is needed. This long and deep evaluation performed by Geriatricians may even require one day. This is the case of the Cancer Center in Lyon, where a special evaluation unit has been mounted. In front of this variable situation in several countries a new effort of SIOG is required to provide further indication of the best possible tools to be adopted taking into account the cultural differences worldwide on one side and on the other. The limited availability, if not the absence of Geriatricians in some countries. An extended MGE cannot in fact be performed without Geriatricians available. In this instance at least some alternative forms of assessment should be envisaged. 11.15–13.50
Session IV: Facing the complexity F5 11.15–13.50 The dimensions of the complexity of treating the senior adult with cancer G. Zulian *. Palliative Medicine, Cesco, Collonge-Bellerive, Geneva, Switzerland The Ten Commandments 1. Senior adults (SA) have gained experience in life. They deserve respect. 2. SA have succeeded to escape premature end of life. They deserve admiration. 3. SA are presenting with more than one disorder. They deserve professional attention. 4. SA have been educated several decades years ago. They deserve honest information. 5. SA are voting citizen and express their willingness with no pressure. They deserve protection. 6. SA are prone to cancer because cancer takes time to develop. They deserve accurate diagnosis. 7. SA are prescribed many drugs despite adverse interactions. They deserve specialized care. 8. SA are accompanied by loved ones and require their help. They deserve time. 9. SA are dealing with used vulnerable or frail organs. They deserve caution. 10. SA are made of the thoughts and beliefs. They deserve freedom. 11. SA are closer to death. They deserve to hold their dignity. After 80 years of a daily working experience, one most certainly knows the job. But, still, the risk of suddenly losing it does exist. Lots of cuts and bruises have produced scars over time which may indeed have healed but not without leaving few aches and pains behind. With media bringing home all sorts of information including new technology and new way of thinking, successful adaptation is crucial for survival. Life is a constant challenge that requires continuous education and training as well as help from various sources. One of them, the mind, may be the most significant problem because it doesn’t fit with the other parts of the organism; either it goes too fast or at such a slow pace that it doesn’t comply with the rules and obligation of performance. And the spoken language is not the one that was learned some time ago, and yet well understood until today. Ideas have evolved whereas most people remain the same throughout their life. This is one reason to explain why disagreements or conflicts happen during normal conversation when listening is replaced by too specialised a speech. In front of the many dimensions captured in one single individual, health professionals have been given specific skills which they should then put into practice. The cancer diagnosed in a person aged 80 years is going to overwhelm its life. Suffering suddenly appears as a likely perspective and death becomes the ultimate target. Multiplication of tests and of treatments
S11
reinforce the bad feeling of the long way to get through, whatever the issue may be. Rehabilitation takes another bunch of residual energy while more time has gone away. Economic resources are not that inexhaustible and the cost to be someone else weight during a given time has no pre-established price. Finally, progressive loss of cognitive function, though not a fatality, may come at last if not at the beginning but not for the least suffering. Health professionals may thus remember the basic ethic principles to coapply knowledge into know-how − beneficiency and non maleficiency – together with savoir-faire and equity while patient’s autonomy finds its achievement in the dignity of being human. F6 About interdisciplinarity
11.15–13.50
M. Farrell *. University at Buffalo, The State University of New York, Buffalo, New York, USA Theories of group development propose that interdisciplinary health care teams must pass through a developmental process before they can function effectively; however the theory has rarely been tested in field settings, in part because of inadequate conceptualization of how teams develop, and in part because of the lack of measures to assess stages of team development. In this paper I present a theory of team development, methods for assessing the stage of team development, and the results of a test of the theory in a study of 111 health care teams in VA hospitals in the United States. In previous papers my colleagues and I have proposed that teams in the early stages of development are often characterized by interpersonal conflict, alienated members, blocked communication, scapegoats, and dependence on one or two members who dominate the interaction. Some members may attempt to compensate for the tension by acting as peacemaker or clown, or by using treats to entice members to come to meetings. Teams develop beyond these early stages by consciously negotiating a shared team culture that reduces anomie. Teams in more advanced stages of development are likely to be characterized by more cohesion, more open communication, more egalitarian interpersonal roles, and less energy tied up in defensive informal roles. Using SYMLOG to measure the informal roles played by team members and a new measure of anomie in teams, I present evidence that as anomie declines, defensive informal roles become less common, interaction becomes more collegial, and teams function more effectively. Drawing on my own experience in leading groups and my historical research on collaborative circles of artists, such as the French Impressionists, I discuss the implications of the findings for developing a well-functioning team. F7 11.15–13.50 Testimony on interdisciplinarity. Will you still treat me when I’m 74?! M.L. Kelly *. MUHC Cancer Mission, Qu´ebec, Montr´eal, Canada Multimodal treatment for gastric cancer, comprising neo-adjuvant and adjuvant chemotherapy has offered hope for greater chance of progression free survival. Although the treatments cause significant toxicities that impact on the well being and functioning of the individual, elderly gastric cancer patients cannot be excluded from these treatments based solely on their age. The complexity of the elderly patient’s medical, functional and social situation challenges the ability of the individual to successfully undertake and complete the treatment. Adequate planning by an interdisciplinary team to foresee and prevent possible complications and to build in adequate support during the treatment can help the individual receive the treatment that is medically necessary. The presentation will describe the case of a 74 year old woman, diagnosed with gastric cancer, who has consented to be treated in a protocol consisting of neo-adjuvant and adjuvant treatment following total gastrectomy. The individual has co-morbidities, and a challenging family situation. The work of the interdisciplinary team to manage the symptoms and support the patient through treatment will be elaborated.
Session IV: Facing the complexity F5 11.15–13.50 The dimensions of the complexity of treating the senior adult with cancer G. Zulian *. Palliative Medicine, Cesco, Collonge-Bellerive, Geneva, Switzerland The Ten Commandments 1. Senior adults (SA) have gained experience in life. They deserve respect. 2. SA have succeeded to escape premature end of life. They deserve admiration. 3. SA are presenting with more than one disorder. They deserve professional attention. 4. SA have been educated several decades years ago. They deserve honest information. 5. SA are voting citizen and express their willingness with no pressure. They deserve protection. 6. SA are prone to cancer because cancer takes time to develop. They deserve accurate diagnosis. 7. SA are prescribed many drugs despite adverse interactions. They deserve specialized care. 8. SA are accompanied by loved ones and require their help. They deserve time. 9. SA are dealing with used vulnerable or frail organs. They deserve caution. 10. SA are made of the thoughts and beliefs. They deserve freedom. 11. SA are closer to death. They deserve to hold their dignity. After 80 years of a daily working experience, one most certainly knows the job. But, still, the risk of suddenly losing it does exist. Lots of cuts and bruises have produced scars over time which may indeed have healed but not without leaving few aches and pains behind. With media bringing home all sorts of information including new technology and new way of thinking, successful adaptation is crucial for survival. Life is a constant challenge that requires continuous education and training as well as help from various sources. One of them, the mind, may be the most significant problem because it doesn’t fit with the other parts of the organism; either it goes too fast or at such a slow pace that it doesn’t comply with the rules and obligation of performance. And the spoken language is not the one that was learned some time ago, and yet well understood until today. Ideas have evolved whereas most people remain the same throughout their life. This is one reason to explain why disagreements or conflicts happen during normal conversation when listening is replaced by too specialised a speech. In front of the many dimensions captured in one single individual, health professionals have been given specific skills which they should then put into practice. The cancer diagnosed in a person aged 80 years is going to overwhelm its life. Suffering suddenly appears as a likely perspective and death becomes the ultimate target. Multiplication of tests and of treatments
S11
reinforce the bad feeling of the long way to get through, whatever the issue may be. Rehabilitation takes another bunch of residual energy while more time has gone away. Economic resources are not that inexhaustible and the cost to be someone else weight during a given time has no pre-established price. Finally, progressive loss of cognitive function, though not a fatality, may come at last if not at the beginning but not for the least suffering. Health professionals may thus remember the basic ethic principles to coapply knowledge into know-how − beneficiency and non maleficiency – together with savoir-faire and equity while patient’s autonomy finds its achievement in the dignity of being human. F6 About interdisciplinarity
11.15–13.50
M. Farrell *. University at Buffalo, The State University of New York, Buffalo, New York, USA Theories of group development propose that interdisciplinary health care teams must pass through a developmental process before they can function effectively; however the theory has rarely been tested in field settings, in part because of inadequate conceptualization of how teams develop, and in part because of the lack of measures to assess stages of team development. In this paper I present a theory of team development, methods for assessing the stage of team development, and the results of a test of the theory in a study of 111 health care teams in VA hospitals in the United States. In previous papers my colleagues and I have proposed that teams in the early stages of development are often characterized by interpersonal conflict, alienated members, blocked communication, scapegoats, and dependence on one or two members who dominate the interaction. Some members may attempt to compensate for the tension by acting as peacemaker or clown, or by using treats to entice members to come to meetings. Teams develop beyond these early stages by consciously negotiating a shared team culture that reduces anomie. Teams in more advanced stages of development are likely to be characterized by more cohesion, more open communication, more egalitarian interpersonal roles, and less energy tied up in defensive informal roles. Using SYMLOG to measure the informal roles played by team members and a new measure of anomie in teams, I present evidence that as anomie declines, defensive informal roles become less common, interaction becomes more collegial, and teams function more effectively. Drawing on my own experience in leading groups and my historical research on collaborative circles of artists, such as the French Impressionists, I discuss the implications of the findings for developing a well-functioning team. F7 11.15–13.50 Testimony on interdisciplinarity. Will you still treat me when I’m 74?! M.L. Kelly *. MUHC Cancer Mission, Qu´ebec, Montr´eal, Canada Multimodal treatment for gastric cancer, comprising neo-adjuvant and adjuvant chemotherapy has offered hope for greater chance of progression free survival. Although the treatments cause significant toxicities that impact on the well being and functioning of the individual, elderly gastric cancer patients cannot be excluded from these treatments based solely on their age. The complexity of the elderly patient’s medical, functional and social situation challenges the ability of the individual to successfully undertake and complete the treatment. Adequate planning by an interdisciplinary team to foresee and prevent possible complications and to build in adequate support during the treatment can help the individual receive the treatment that is medically necessary. The presentation will describe the case of a 74 year old woman, diagnosed with gastric cancer, who has consented to be treated in a protocol consisting of neo-adjuvant and adjuvant treatment following total gastrectomy. The individual has co-morbidities, and a challenging family situation. The work of the interdisciplinary team to manage the symptoms and support the patient through treatment will be elaborated.